Patient compliance puts a lot of weight on the Healthcare system. Improving medication adherence is critical not only for the patients’ health but also to reduce the $100-$289 billion a year associated with medication nonadherence.
Technologies from text messages up to smart pills are ways to limit poor adherence.
In this article, we will go through the various ways for patients to stick to their prescriptions. Considering that up to 50% of chronically ill patients do not comply with their doctor’s prescription, patient medication adherence is a health care issue that needs to be solved.
Text Messages
Text Messages are not cutting-edge technology and are seldomly used anymore except by telemarketers, maybe? In 2016, a team from the Department of Cardiology conducted a meta-analysis of the clinical studies to assess the benefits of sending regular text messages to chronically ill patients.
In the 2,742 patients followed, the compliance improved from 50% up to 67.8%. These results showed that even old-fashion technology could have a very positive impact on reducing medication nonadherence.
In another study conducted in China in 2019, the authors analyzed six studies involving 1,678 cardiac patients.
Text messages significantly promoted medication adherence, a 2.85 times improvement. They also reduced systolic Blood Pressure, cholesterol level, and body mass index but did not affect mortality and diastolic Blood Pressure.
It is difficult to explain the differences in biological parameters, but the primary variable, adherence, was positively impacted.
Apps
Apps for smartphones are a more modern equivalent of text messages. Numerous apps exist either for iOS or Android that will help improve medication adherence, even though they can sometimes be complex to set up.
We tried many of them and did not find a single one that we will keep using long-term. Not that we are not diligent with our pills, but another positive effect of these electronic reminders is to let you know if you already took your pills or not.
Those of you suffering from the chronic disease will agree that it can sometimes be difficult to remember if you already took your medicine or not….especially in the morning before drinking a couple of cups of coffee.
In 2019, Dr. Laura Catherine Armitage from the University of Oxford in the UK conducted a large meta-analysis of the literature dealing with the effect of mobile phone apps. on medication adherence. The researched the studies published from 1990 up to November 2018.
Out of 83 screened studies, nine were deemed methodologically robust and were included. The intervention field of the Apps included patients suffering from various types of conditions, including cardiovascular disease, depression, Parkinson’s disease, and psoriasis.
The authors concluded that app-based medication adherence had positive effects even though more studies were required.
Even though the apps. seem promising in improving patients’ medication-taking behavior, they are not created equal and often lack the involvement of healthcare professionals in their development.
In 2018, a team from the Imperial College in London conducted a systematic review of all medication compliance apps available on the two leading platforms. They checked their quality, relevance in improving patient outcomes, and adherence strategy used.
Three strategies were defined:
- Reminder,
- Behavioral and,
- Patient Education.
Out of 5,881 apps identified on the Apple App. Store and Google Play Store, 420 free ones were judged are relevant for the analysis.
Among the 420 selected apps, some statistics raise concerns on the quality of their development and potential for improving health outcomes and patient adherence.
- Out of 420 free apps, only 57 or 13.5 percent of them involved a Health Care Professional during their development process,
- 250 apps only used a single method to limit poor medication adherence,
- 149 used two methods,
- Only 22, or 5 percent, combined the three methods to improve the adherence rate.
Apps. have to be scientifically accurate and relevant, but they must also be engaging and well accepted by the patients. In Feb. 2021, a team of researchers in Switzerland published an interesting study in which they ranked what the three best apps were. as far as science was concerned and the best three in the patients’ eyes.
Surprisingly, the rankings were different. The best three, scientifically speaking, were Medisafe, MyTherapy, and Meds in Time and Dosecast, Medisafe, and SwissMeds for the patients.
Connected pillboxes
Connected or smart pillboxes are not new. However, in 2008, doctors showed that this technology could be beneficial to keep track of the prescribed medication.
When coupled to a telemedicine program, connected pillboxes proved very useful in improving medication adherence in diabetics patients. As a result, 80% of the patients who have diabetes stick to their treatment.
Pillboxes have come a long way from a simple letter-coded plastic rack. The latest models are connected to the Internet and communicate via Bluetooth with your smartphone to track medication adherence rates.
Two of the smartest are the Hero Automatic Medication Dispenser and the e-pill MedSmart Plus.
Hero Automatic Medication Dispenser
The Hero is more than a smart pillbox. This 10 pounds connected medicine cabinet can store up to 90’s day supply of 10 different medications. Being connected to an iOS or Android smartphone will remind you when to take your pills, dispense them for you and even synchronize with the caregiver dashboard for medication synchronization.
HIPAA compliant, this clever smartbox is not free, though, and comes on a subscription ($29.99/month) with an additional $49.99 initiation fee.
e-Pill MedSmart Plus
The e-Pill MedSmart Plus (Check on Amazon) stores up to 28 days of drugs and helps patients stick to their medication regimen. Lockable, it will prevent kids from having the pills. For people living alone, the box can be filled up regularly by the caregiver.
Not connected, the e-Pill is thought to elderly take their meds at predefined times. The box can store multiple medications, will talk and inform the user that it is time to take their meds.
Telemedicine
Telehealth tools took a lot of traction during the Covid pandemics, but telemedicine improved patients’ adherence.
In May 2021, a meta-analysis including 13 out of 8,693 studies covering 1998 up to 2019 period on patients suffering from chronic conditions concluded that any telemedicine modalities, from phone call up to specialized tools, significantly improved medication in patients with type 2 diabetes, hypertension, and/or dyslipidemia.
Telemedicine also proved to be beneficial for older adults who are homebound during Covid-19, according to a study published on September 9, 2021 in JAMA Open Science Network.
Ingestible Sensors
Smart Pills are the ultimate technology when it comes to a non-adherent patient. Pills contain an edible electronic element that will activate in the stomach and transmit a signal to an external receiver that synchronizes the information with a smartphone.
Despite their potential, the main issue of the smart pills relates to their price. Proteus Digital Health led the development in this field and was once valued at over $1.5 billion.
The high price of the pills. technical challenges and difficulties in making patients suffering from mental disorders commit to the treatment led to Proteus filing for bankruptcy, proving that despite their many benefits, smart pills are still hard to swallow.
To wrap up
With so many technologies available, it is to hope that the adherence rate will increase in the years to come.
One of the critical elements somehow related to patient education and is the ultimate and probably the number one challenge on how to improve medication adherence.
